This profile defines the patient's diagnostic tests.

This profile defines the patient's diagnostic tests.

これは単一のレポートをキャプチャすることを目的としており、複数のレポートをカバーする要約情報の表示に使用するのには適していない。たとえば、このリソースは、検査結果の累積レポート形式やシーケンスの詳細な構造化レポート用に作られていない。

【JP Core仕様】DiagnosticReportリソースの共通プロフィール

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

An Extension

Identifiers assigned to this report by the performer or other systems. 実施者または他のシステムによってこのレポートに割り当てられた識別子。

Usually assigned by the Information System of the diagnostic service provider (filler id). 発生源の検査室からこのレポートについてクエリを作成するとき、およびFHIRコンテキスト外のレポートにリンクするときに使用する識別子を知る必要がある。

【JP Core仕様】レポートをユニークに識別する識別子。依頼者オーダ番号と関連付ける場合が多い。

検体検査の特性として、複数の容器の結果を含む。容器ごと（厳密には項目ごと）に結果のタイミングは異なる場合がある。

発生源の検査室からこのレポートについてクエリを作成するとき、およびFHIRコンテキスト外のレポートにリンクするときに使用する識別子を知る必要がある。

依頼されたサービス（検査や診断など）に関する詳細情報

Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports. 通常、１結果ごとに１つの検査依頼があるが、状況によっては、複数の検査要求に対して１レポートがある場合がある。また 1つの検査依頼に対して複数のレポートが作成される場合もあることに注意。

【JP Core仕様】ServiceRequestリソースを参照(ObservationLabResultと同様）

This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

The status of the diagnostic report.　診断レポートのステータス。

Note that FHIR strings SHALL NOT exceed 1MB in size

有れば：ORC-5

もしくは

無ければ：OBR-25("F")のAND結果

　例：全部"F"なら"F"、それ以外の場合は要検討

設定する値は、DiagnosticReportStatus（コード）から1つ選ぶ

コード体系：HL7 Table 0038のコードと定義

The status of the diagnostic report.

Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

レポートを作成した臨床分野、部門、または診断サービス（心臓病学、生化学、血液学、MRIなど）を分類するコード。これは、検索、並べ替え、および表示の目的で使用される。

さまざまなカテゴリ化スキームを使用して、複数のカテゴリを使用できる。粒度のレベルは、それぞれの値セットのカテゴリの概念によって定義される。 DiagnosticReport.codeのメタデータや用語の階層を使用して、よりきめ細かいフィルタリングを実行できる。

Codes for diagnostic service sections.

レポートを作成した臨床分野、部門、または診断サービス（心臓病学、生化学、血液学、MRIなど）を分類するコード。これは、検索、並べ替え、および表示の目的で使用される。

Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code. さまざまなカテゴリ化スキームを使用して、複数のカテゴリを使用できる。粒度のレベルは、それぞれの値セットのカテゴリの概念によって定義される。 DiagnosticReport.codeのメタデータや用語の階層を使用して、よりきめ細かいフィルタリングを実行できる。

【JP Core仕様】Diagnostic Service Section Codesの"LAB"を使用

Codes for diagnostic service sections.

この診断レポートを説明するコードまたは名前。

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素と事前・事後の用語作成（pre- and post-coordination）との関係を管理するための独自の構造を提供する必要がある。

【JP Core仕様】LOINCの臨床検査の分類コードを割り当てる。

検査レポートの利用用途に合わせて、JLAC10のコードを振っても良い。

Codes that describe Diagnostic Reports.

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

検体検査レポート項目コード。本ユースケースにおける項目コード推奨値をスライスにて示している。

推奨コードは必須ではない、派生先によるコード体系を作成し割り振ることを否定しない

Allows for alternative encodings within a code system, and translations to other code systems.

レポートの対象、常にではないが、通常、患者。ただし、診断サービスは、他のさまざまなソースから収集された検体を対象とすることもある。

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. 参照は、実際のFHIRリソースへの参照である必要があり、内容に辿り着ける（解決できる）必要がある（アクセス制御、一時的な使用不可などを考慮に入れる）。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。

【JP Core仕様】Patientリソースを参照

SHALL know the subject context.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

このDiagnosticReportが対象とするヘルスケアイベント（患者とヘルスケアプロバイダの相互関係など）。受診、入院、診察など。

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

【JP Core仕様】入院外来の区別や所在場所、担当診療科の情報に使用する。

※このプロファイルの用途では通常は必須と考えられるが、ユースケースにより使用されない場合を考慮し、1..1に制約しない。

Links the request to the Encounter context.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

観測値が関連する時間または期間。レポートの対象が患者である場合、これは通常、処置や検体採取の時刻のいずれかであるが、日付/時刻の出処は不明であり、日付/時刻自体のみのことがある。

If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic. 診断手順が患者に対して実行された場合、これは実施された時刻。対象が検体である場合は、検体採取時間から診断関連時刻を導き出すことができるが、検体情報が常に入手できるとは限らず、検体と診断関連時刻の正確な関係は必ずしも自明ではない。

【JP Core仕様】検体採取時間

Need to know where in the patient history to file/present this report.

このバージョンのレポートが医療者に提供された日時。通常、レポートがレビューおよび検証・確定された後となる。

May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report. リソース自体の更新時刻とは異なる場合がある。これは、レポートの実際の提供時刻ではなく、リソース自体の更新時刻はレコード（場合によってはセカンダリコピー）のステータスの更新時刻となるため。

【JP Core仕様】このデータが出来た時間

Clinicians need to be able to check the date that the report was released.

レポートの作成発行に責任をもつ診断サービス。

This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report. 必ずしも１項目データ単位のデータソースまたは結果を解釈した主体でなない。臨床レポートに責任をもつ主体のこと。

【JP Core仕様】検査に関わった人もしくは組織

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

レポートの結論と解釈に責任を持つ医療者あるいは組織。

Might not be the same entity that takes responsibility for the clinical report. レポートに責任を持つ主体とは異なる場合がある。

【JP Core仕様】検査責任者

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

この診断レポートのもとになった検体に関する詳細情報。

If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group. 検査結果名称のコードを見れば検体情報が十分に判明するような場合には、この検体情報は冗長になる。複数の検体が関与する場合には、検査や検査グループごとに検体情報が記述されることがある。

【JP Core仕様】該当するspecimenを設定

Need to be able to report information about the collected specimens on which the report is based.

Observations that are part of this diagnostic report. 診断レポートの一部

Observations can contain observations. Observationはobservationを含みうる。

【JP Core仕様】該当するObservationを設定

個々の結果または結果のグループをサポートする必要がある。結果のグループ化は任意だが、意味がある場合にグループ化される。

Observations that are part of this diagnostic report. 診断レポートの一部

Observations can contain observations. Observationはobservationを含みうる。

【JP Core仕様】該当するObservationを設定

個々の結果または結果のグループをサポートする必要がある。結果のグループ化は任意だが、意味がある場合にグループ化される。

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

診断的精査中に実施されたなんらかの画像検査の詳細情報へのひとつ以上のリンク。通常は、DICOM対応のモダリティーによって実施される画像検査であるが、必須ではない。完全対応のPACSビューワはこの情報を使用して原画像の一覧を提供できる。

ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided. ImagingStudyと画像要素は多少重複する。通常、画像要素内の画像参照のリストは、画像検査リソースのひとつにも存在する。。ただし、それぞれがさまざまなタイプの目的のためにさまざまなタイプのディスプレイに対応している。どちらも、どちらか、または両方を提供することはできない。

【JP Core仕様】使わない

このレポートに関連する主要な画像のリスト。画像は通常、診断プロセス中に作成され、患者から直接か、調製された検体標本（つまり、関心のあるスライド）のこともある。

【JP Core仕様】レポート1つに対して、複数の画像・コメントがぶら下がる

Many diagnostic services include images in the report as part of their service.

Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report. 診断レポートの簡潔で臨床的に文脈化された要約結論（解釈/印象）。

Note that FHIR strings SHALL NOT exceed 1MB in size

【JP Core仕様】原則使わない

Need to be able to provide a conclusion that is not lost among the basic result data.

診断レポートの要約的な結論（解釈/印象）を表す1つ以上のコード。

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素と事前・事後の用語作成（pre- and post-coordination）との関係を管理するための独自の構造を提供する必要がある。

【JP Core仕様】原則使わない

Diagnosis codes provided as adjuncts to the report.

診断サービスによって発行された結果全体のリッチテキスト表現。複数のフォーマットが許可されるが、それらは意味的に同等である必要がある。

"application/pdf" is recommended as the most reliable and interoperable in this context. application / pdf」がこのコンテキストで最も信頼でき相互運用可能なものとして推奨される。

【JP Core仕様】原則使わない

Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

This profile defines the patient's diagnostic tests.

これは単一のレポートをキャプチャすることを目的としており、複数のレポートをカバーする要約情報の表示に使用するのには適していない。たとえば、このリソースは、検査結果の累積レポート形式やシーケンスの詳細な構造化レポート用に作られていない。

【JP Core仕様】DiagnosticReportリソースの共通プロフィール

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human language.

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

An Extension

An Extension

Identifiers assigned to this report by the performer or other systems. 実施者または他のシステムによってこのレポートに割り当てられた識別子。

Usually assigned by the Information System of the diagnostic service provider (filler id). 発生源の検査室からこのレポートについてクエリを作成するとき、およびFHIRコンテキスト外のレポートにリンクするときに使用する識別子を知る必要がある。

【JP Core仕様】レポートをユニークに識別する識別子。依頼者オーダ番号と関連付ける場合が多い。

検体検査の特性として、複数の容器の結果を含む。容器ごと（厳密には項目ごと）に結果のタイミングは異なる場合がある。

発生源の検査室からこのレポートについてクエリを作成するとき、およびFHIRコンテキスト外のレポートにリンクするときに使用する識別子を知る必要がある。

依頼されたサービス（検査や診断など）に関する詳細情報

Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports. 通常、１結果ごとに１つの検査依頼があるが、状況によっては、複数の検査要求に対して１レポートがある場合がある。また 1つの検査依頼に対して複数のレポートが作成される場合もあることに注意。

【JP Core仕様】ServiceRequestリソースを参照(ObservationLabResultと同様）

This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

The status of the diagnostic report.　診断レポートのステータス。

Note that FHIR strings SHALL NOT exceed 1MB in size

有れば：ORC-5

もしくは

無ければ：OBR-25("F")のAND結果

　例：全部"F"なら"F"、それ以外の場合は要検討

設定する値は、DiagnosticReportStatus（コード）から1つ選ぶ

コード体系：HL7 Table 0038のコードと定義

The status of the diagnostic report.

Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

レポートを作成した臨床分野、部門、または診断サービス（心臓病学、生化学、血液学、MRIなど）を分類するコード。これは、検索、並べ替え、および表示の目的で使用される。

さまざまなカテゴリ化スキームを使用して、複数のカテゴリを使用できる。粒度のレベルは、それぞれの値セットのカテゴリの概念によって定義される。 DiagnosticReport.codeのメタデータや用語の階層を使用して、よりきめ細かいフィルタリングを実行できる。

Codes for diagnostic service sections.

レポートを作成した臨床分野、部門、または診断サービス（心臓病学、生化学、血液学、MRIなど）を分類するコード。これは、検索、並べ替え、および表示の目的で使用される。

Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code. さまざまなカテゴリ化スキームを使用して、複数のカテゴリを使用できる。粒度のレベルは、それぞれの値セットのカテゴリの概念によって定義される。 DiagnosticReport.codeのメタデータや用語の階層を使用して、よりきめ細かいフィルタリングを実行できる。

【JP Core仕様】Diagnostic Service Section Codesの"LAB"を使用

Codes for diagnostic service sections.

この診断レポートを説明するコードまたは名前。

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素と事前・事後の用語作成（pre- and post-coordination）との関係を管理するための独自の構造を提供する必要がある。

【JP Core仕様】LOINCの臨床検査の分類コードを割り当てる。

検査レポートの利用用途に合わせて、JLAC10のコードを振っても良い。

Codes that describe Diagnostic Reports.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A reference to a code defined by a terminology system.

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Allows for alternative encodings within a code system, and translations to other code systems.

検体検査レポート項目コード。本ユースケースにおける項目コード推奨値をスライスにて示している。

推奨コードは必須ではない、派生先によるコード体系を作成し割り振ることを否定しない

Allows for alternative encodings within a code system, and translations to other code systems.

A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

Very often the text is the same as a displayName of one of the codings.

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

レポートの対象、常にではないが、通常、患者。ただし、診断サービスは、他のさまざまなソースから収集された検体を対象とすることもある。

References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. 参照は、実際のFHIRリソースへの参照である必要があり、内容に辿り着ける（解決できる）必要がある（アクセス制御、一時的な使用不可などを考慮に入れる）。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。

【JP Core仕様】Patientリソースを参照

SHALL know the subject context.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

このDiagnosticReportが対象とするヘルスケアイベント（患者とヘルスケアプロバイダの相互関係など）。受診、入院、診察など。

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

【JP Core仕様】入院外来の区別や所在場所、担当診療科の情報に使用する。

※このプロファイルの用途では通常は必須と考えられるが、ユースケースにより使用されない場合を考慮し、1..1に制約しない。

Links the request to the Encounter context.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

観測値が関連する時間または期間。レポートの対象が患者である場合、これは通常、処置や検体採取の時刻のいずれかであるが、日付/時刻の出処は不明であり、日付/時刻自体のみのことがある。

If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic. 診断手順が患者に対して実行された場合、これは実施された時刻。対象が検体である場合は、検体採取時間から診断関連時刻を導き出すことができるが、検体情報が常に入手できるとは限らず、検体と診断関連時刻の正確な関係は必ずしも自明ではない。

【JP Core仕様】検体採取時間

Need to know where in the patient history to file/present this report.

このバージョンのレポートが医療者に提供された日時。通常、レポートがレビューおよび検証・確定された後となる。

May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report. リソース自体の更新時刻とは異なる場合がある。これは、レポートの実際の提供時刻ではなく、リソース自体の更新時刻はレコード（場合によってはセカンダリコピー）のステータスの更新時刻となるため。

【JP Core仕様】このデータが出来た時間

Clinicians need to be able to check the date that the report was released.

レポートの作成発行に責任をもつ診断サービス。

This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report. 必ずしも１項目データ単位のデータソースまたは結果を解釈した主体でなない。臨床レポートに責任をもつ主体のこと。

【JP Core仕様】検査に関わった人もしくは組織

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

レポートの結論と解釈に責任を持つ医療者あるいは組織。

Might not be the same entity that takes responsibility for the clinical report. レポートに責任を持つ主体とは異なる場合がある。

【JP Core仕様】検査責任者

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

この診断レポートのもとになった検体に関する詳細情報。

If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group. 検査結果名称のコードを見れば検体情報が十分に判明するような場合には、この検体情報は冗長になる。複数の検体が関与する場合には、検査や検査グループごとに検体情報が記述されることがある。

【JP Core仕様】該当するspecimenを設定

Need to be able to report information about the collected specimens on which the report is based.

Observations that are part of this diagnostic report. 診断レポートの一部

Observations can contain observations. Observationはobservationを含みうる。

【JP Core仕様】該当するObservationを設定

個々の結果または結果のグループをサポートする必要がある。結果のグループ化は任意だが、意味がある場合にグループ化される。

Observations that are part of this diagnostic report. 診断レポートの一部

Observations can contain observations. Observationはobservationを含みうる。

【JP Core仕様】該当するObservationを設定

個々の結果または結果のグループをサポートする必要がある。結果のグループ化は任意だが、意味がある場合にグループ化される。

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

診断的精査中に実施されたなんらかの画像検査の詳細情報へのひとつ以上のリンク。通常は、DICOM対応のモダリティーによって実施される画像検査であるが、必須ではない。完全対応のPACSビューワはこの情報を使用して原画像の一覧を提供できる。

ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided. ImagingStudyと画像要素は多少重複する。通常、画像要素内の画像参照のリストは、画像検査リソースのひとつにも存在する。。ただし、それぞれがさまざまなタイプの目的のためにさまざまなタイプのディスプレイに対応している。どちらも、どちらか、または両方を提供することはできない。

【JP Core仕様】使わない

このレポートに関連する主要な画像のリスト。画像は通常、診断プロセス中に作成され、患者から直接か、調製された検体標本（つまり、関心のあるスライド）のこともある。

【JP Core仕様】レポート1つに対して、複数の画像・コメントがぶら下がる

Many diagnostic services include images in the report as part of their service.

Concise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report. 診断レポートの簡潔で臨床的に文脈化された要約結論（解釈/印象）。

Note that FHIR strings SHALL NOT exceed 1MB in size

【JP Core仕様】原則使わない

Need to be able to provide a conclusion that is not lost among the basic result data.

診断レポートの要約的な結論（解釈/印象）を表す1つ以上のコード。

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素と事前・事後の用語作成（pre- and post-coordination）との関係を管理するための独自の構造を提供する必要がある。

【JP Core仕様】原則使わない

Diagnosis codes provided as adjuncts to the report.

診断サービスによって発行された結果全体のリッチテキスト表現。複数のフォーマットが許可されるが、それらは意味的に同等である必要がある。

"application/pdf" is recommended as the most reliable and interoperable in this context. application / pdf」がこのコンテキストで最も信頼でき相互運用可能なものとして推奨される。

【JP Core仕様】原則使わない

Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.